Incorporation of Edited MRS into Clinical Practice May Improve Care of Patients with IDH -Mutant Glioma

• Published in: American journal of neuroradiology : AJNR Vol. 46; no. 1; pp. 113 - 120
• Main Authors: Nichelli, Lucia, Cadin, Capucine, Lazzari, Patrizia, Mathon, Bertrand, Touat, Mehdi, Sanson, Marc, Bielle, Franck, Marjańska, Małgorzata, Lehéricy, Stéphane, Branzoli, Francesca
• Format: Journal Article
• Language: English
• Published: United States 01.01.2025
• Subjects: Adult; Aged; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - genetics; Brain Neoplasms - metabolism; Female; Glioma - diagnostic imaging; Glioma - genetics; Glioma - metabolism; Glutarates - metabolism; Humans; Isocitrate Dehydrogenase - genetics; Magnetic Resonance Spectroscopy - methods; Male; Middle Aged; Mutation; Prospective Studies; Young Adult
• DOI: 10.3174/ajnr.A8413
• ISSN: 0195-6108; 1936-959X

Isocitrate dehydrogenase ( ) mutation and 1p/19q codeletion classify adult-type diffuse gliomas into 3 tumor subtypes with distinct prognoses. We aimed to evaluate the performance of edited MR spectroscopy for glioma subtyping in a clinical setting, via the quantification of D-2-hydroxyglutarate (2HG) and cystathionine. The delay between this noninvasive classification and the integrated histomolecular analysis was also quantified. Subjects with presumed low-grade gliomas eligible for surgery (cohort 1) and subjects with -mutant gliomas previously treated and with progressive disease (cohort 2) were prospectively examined with a single-voxel Mescher-Garwood point-resolved spectroscopy sequence at 3T. Spectra were quantified using LCModel. The Cramér-Rao lower bounds threshold was set to 20%. Integrated histomolecular analysis according to the 2021 WHO classification was considered as ground truth. Thirty-four consecutive subjects were enrolled. Due to poor spectra quality and lack of histologic specimens, data from 26 subjects were analyzed. Twenty-one belonged to cohort 1 (11 women; median age, 42 years); and 5, to cohort 2 (3 women; median age, 48 years). Edited MR spectroscopy showed 100% specificity for detection of -mutation and 91% specificity for the prediction of 1p/19q-codeletion status. Sensitivities for the prediction of and 1p/19q codeletion were 69% and 33%, respectively. The median Cramér-Rao lower bounds values were 16% (13%-28%) for -mutant and 572% (554%-999%) for wild type tumors. The time between MR spectroscopy and surgery was longer for low-grade than for high-grade gliomas ( = .03), yet the time between MR spectroscopy and WHO diagnosis did not differ between grades ( = .07), possibly reflecting molecular analyses-induced delays in high-grade gliomas. Our results, acquired in a clinic setting, confirmed that edited MR spectroscopy is highly specific for both mutation and 1p/19q-codeletion predictions and can provide a faster prognosis stratification. In the upcoming IDH-inhibitor treatment era, incorporation of edited MR spectroscopy into clinical workflow is desirable.